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A comparative cost analysis of newborn screening for classic congenital adrenal hyperplasia in Texas
C A Brosnan1, P Brosnan, B L Therrell
1School of Nursing, Univ. of Texas--Houston 77030, USA. cbrosnan@son1.nur.uth.tmc.edu
Insights
Texas
Area of Science:
- Medical screening
- Pediatric endocrinology
- Public health policy
Background:
- Texas employs a two-stage newborn screening for congenital adrenal hyperplasia (CAH).
- Congenital adrenal hyperplasia (CAH) is a group of genetic disorders affecting the adrenal glands.
- Early detection of CAH is crucial for preventing severe health complications.
Purpose of the Study:
- To compare the cost-effectiveness of clinical diagnosis versus the two-test newborn screening program for CAH in Texas.
- To evaluate the utility of each screening test in identifying infants with different forms of CAH.
Main Methods:
- Cost analysis of the 1994 Texas newborn screening program for CAH.
- Inclusion of direct costs to the Texas Department of Health and broader societal costs.
- Comparison of costs for clinically diagnosed cases versus screen-detected cases.
Main Results:
- In 1994, 15 infants with classic CAH were diagnosed in Texas (incidence 1:21,701).
- The first screen detected all severe salt-wasting CAH cases; the second screen identified additional simple virilizing CAH cases.
- The first screen was more cost-effective ($115,169 per infant) than the second screen ($242,865 per infant).
Conclusions:
- A single newborn screen is effective for early diagnosis of severe salt-wasting CAH.
- The second screen is necessary for detecting simple virilizing CAH but is less cost-effective.
- Screening program costs vary significantly based on the form of CAH detected.
Objective:
Texas mandates a two-test newborn screening program for congenital adrenal hyperplasia (CAH): one test at birth and a second test at approximately one to two weeks after birth. The authors compared the dollar cost of detecting infants with CAH clinically and through the screening program.
Methods:
The authors estimated the costs of screening newborns in 1994 for CAH, including resources used by the Texas Department of Health and the broader cost to society.
Results:
Fifteen infants with classic CAH were diagnosed in Texas in 1994 among 325,521 infants born (1:21,701 cumulative incidence). Seven infants were detected clinically and the others were detected through screening, six on the first screen and two on the second screen. The first screen identified all previously undetected infants with severe salt-wasting CAH. The cumulative cost to diagnose the seven infants detected clinically was $79,187. The incremental costs for the screening program were $115,169 per additional infant diagnosed through the first screen and $242,865 per additional infant diagnosed through the second screen.
Conclusions:
If the goal is early diagnosis of infants with the severe salt-wasting form of CAH, a single screen is effective. If the goal is to detect infants with the simple virilizing form of the disorder who may benefit from early treatment, the second screen is necessary, but it is not as cost-effective as the first screen.
